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To assess the prevalence of sex work and its associations with substance use among female bar/spa workers in the Philippines (N = 498), workers from 54 bar or spa venues in Metro Manila (2009-2010) were surveyed on demographics, drug/alcohol use, abuse history, and sex work. Their median age was 23 years and 35% engaged in sex work. Sex work was independently associated with methamphetamine use (19% vs 4%; adjusted odds ratio [AOR] =2.9, 95% confidence interval [CI] = 1.3-6.2), alcohol use with patrons (49% vs. 27%; AOR = 1.9, 95% CI = 1.1-3.4), and alcohol intoxication during sex (50% vs. 24%; AOR = 2.0, 95% CI = 1.2-3.5), but inversely associated with daily alcohol use (13% vs. 16%; AOR = 0.2, 95% CI = 0.1-0.5). Additional significant covariates included sexual abuse history, younger age, and not having a higher education. Findings suggest that interventions with sex workers in bars and spas should focus on methamphetamine use, alcohol use contexts, and violence victimization, to better meet the needs of this population.

Summary. Background: It is probable that the variety and frequency of delayed adverse vascular events after splenectomy are underappreciated. Splenectomy is performed for a wide variety of conditions, and delayed postsplenectomy hazards are not often studied. Objective: To estimate the relative risk of adverse vascular events in members of hereditary spherocytosis families who have or have not had a splenectomy. Methods: Members of families in which hereditary spherocytosis exists were systematically questioned about adverse vascular events. Results: The cumulative incidence of arterial and venous events at age 70 years was greater in persons who had undergone a splenectomy for spherocytosis (arterial, 22% females, 32% males; venous, 20% females, 19% males) than in affected persons who did not undergo splenectomy (arterial, 3% females, 2% males; venous, 6% females, 4% males) or non-affected family members (arterial, 10% females, 17% males; venous, 4% females, 12% males). Affected subjects who undergo splenectomy are at greatly increased risk of arterial events as compared to affected subjects who do not undergo splenectomy [arterial, hazard ratio (HR) 7.2, 95% confidence interval (CI) 2.8–17.2; venous, HR 3.3, 95% CI 1.1–9.8]. Conclusion: There is a significant, long-lasting, increased risk of adverse arterial and venous thromboembolic events after splenectomy performed for hereditary spherocytosis. A review of the literature indicates that this is also true when splenectomy is performed for several other indications.

The substance abuse field has identified a range of evidence-based substance abuse treatment approaches. Evidence-based approaches are those that have been shown, through carefully controlled and replicated research, to be efficacious or effective. These approaches have been articulated in National Institute on Drug Abuse (NIDA, 2000b) publications and on the NIDA Web site. Research literature, newsletters, and editorials aimed at providers of substance abuse treatment services have also articulated evidence-based approaches. Organizations serving large populations of substance-abusing clients need to be aware of evidence-based practices and use them when developing client service plans. One of the largest social services systems working with substance-abusing clients is the child welfare system. Child welfare agencies have become knowledgeable about substance abuse treatment, but relatively little is known about the extent to which child welfare practice remains current with advances in substance abuse practice. This study examines the extent to which methadone maintenance (MM) is discussed in the child welfare literature and broader social work literature, and the extent to which child welfare policies mention and recommend this treatment method. Why focus on MM as an evidence-based drug treatment practice? Briefly, we know that heroin-dependent women who are parents are likely to provide inadequate care to their children and may expose their family to drug-related violence (Schilling, Mares, & El-Bassel, 2003). The American Public Health Association (1997), NIDA (2000a, 2000b), the World Health Organization (WHO) (2001), Stimson, Des Jarlais, and Ball (1998), the Center for Substance Abuse Treatment (CSAT) (1999), and the Substance Abuse and Mental Health Services Administration (SAMHSA) (1999) identify MM as an effective treatment for heroin dependence. Many studies have shown that opiate-dependent individuals on MM are likely to exhibit reductions in HIV risk behavior and crime and violence and improvements in child rearing and employment (Kott, Habel, & Nottingham, 2001; see Sorensen & Copeland, 2000, for a review). Child welfare is arguably the practice arena most widely recognized as the domain of social workers. Social workers recognize the importance of their state-sanctioned roles in protecting children (Barth & Jonson-Reid, 2000). In this capacity, social workers are required to investigate the well-being of children who are thought to be in danger, make judgments about levels of risk, and recommend courses of action. Social workers who find evidence of abuse or neglect usually recommend some corrective action by parents. In most instances, family court judges accept all or some of these recommendations and stipulate that court sanctions, including removal of the child from the home, remain in effect until the parents at least partially complete a recommended course of action. Wielding considerable power in such matters, social workers make the initial judgment that a child is in danger. Social workers then make recommendations to the court based on their determination, through their own investigation and through assessments of mental health consultants, of the family deficits contributing to child maltreatment. Critical is the social worker's knowledge of optimal and available resources, services, supports, and treatments. In recent decades, parental substance abuse has been shown to be a large contributing factor in child maltreatment (Bays, 1990; Olsen, Allen, & Azzi-Lessing, 1996; Wolack & Magura, 1996). A National Institute of Mental Health (NIMH)-funded study found that substance abusers had three times the odds of committing physical abuse and neglect after controlling for social, demographic, and psychiatric variables (Chaffin, Kelleher, & Hollenberg, 1996). Another study found that more than three-quarters of state child protection administrators across the country reported substance abuse as one of the top two problems presented by their caseloads (Wiese & Daro, 1995). …

This study examined the relationship between sex trading and psychological distress among a nonrandom sample of women recruited from 3 methadone maintenance clinics in New York City. Face-to-face interviews with 280 women (M age = 40.7) revealed that 32% had traded sex for money or drugs in the previous year. Compared to other participants, these women reported less education and higher rates of incarceration in the past year, sexually transmitted diseases, childhood sexual abuse, partner abuse, and current regular crack/cocaine and alcohol use. Hierarchical multiple regression analysis indicated that sex traders scored 0.41 units higher than non-sex traders on the General Severity Index of the Brief Symptom Inventory after controlling for all relevant covariates. The findings emphasize the need to consider the interrelation of psychological distress, abuse, and addiction in designing public health interventions addressing methadone maintained women.

This study investigated the utility and psychometric properties of the University of Rhode Island Change Assessment Scale (URICA) in a sample of 257 female inmates from a large urban prison. It addressed three major issues: (a) whether URICA captures stages of change among female offenders with a recent history of drug abuse; (b) whether distinct, reliable subgroup profiles would emerge from a cluster analysis of the URICA scale; and (c) whether women in these clusters would differ in their demographic characteristics, drug-use patterns, or psychological symptoms. Results indicate that the URICA is a useful, reliable, and valid tool to assess stages of change in drug-using incarcerated women. Consistent with other studies conducted with different populations, the scale yielded five distinct stages: precontemplation, contemplation, preparation, action, and maintenance. Cluster analysis using the hierarchical agglomerate method classified the subjects into five clusters, which correlated with subjects' psychological symptoms. Intervention implications of URICA are discussed.

Background and Objectives:Small ethnographic and clinic-based studies indicate that crack-smoking sex workers are at high risk for human immunodeficiency virus (HIV) and sexually transmitted diseases (STD).Study Goals:To examine the prevalence of risky sexual behaviors and HIV and STD in a large sam

Despite the scope of the HIV/AIDS epidemic among female offenders, little is known about the risk behaviors of these women and even less about ways in which to reduce HIV/AIDS among this population. This article describes the development of an eight-session group cognitive-behavioral and social support enhancement intervention that aims to reduce HIV risk among drug-using female offenders. The intervention is based on social-cognitive theory and informed by other skills-training approaches with demonstrated efficacy at reducing HIV risk. Both current and former offenders were involved in the development of this intervention. Help-seeking and social support skills are unique to this intervention, as is an eight-session booster conducted after release from jail to enhance transfer of skills to the community.

Although investigators have studied HIV-related behavior and attitudes in prisons, little is known about HIV/AIDS phenomena in work release or other alternative forms of incarceration. This study examined the sexual- and drug-risk behavior of 270 male drug users in three work-release facilities located in New York City, comparing their self-reported risk profiles to findings from studies of related high-risk samples in other settings. The respondents reported lower rates of current drug use (heroin, crack cocaine, and alcohol), injection drug use, sexual risk taking, and sexually transmitted diseases than did these comparison groups, and the respondents reported comparable rates of condom use. The rates of most HIV-related risk behaviors in this sample were substantially lower than those reported in other studies of comparison populations. Explanations for these unexpectedly low rates of self-reported risk behavior are offered, and ways in which to overcome practical and methodological challenges that arise in conducting HIV/AIDS research in transitional correctional settings are suggested.

Splenectomy is indicated in hereditary spherocytosis to relieve symptoms due to anaemia or splenomegaly, reverse growth failure or skeletal changes due to over-robust erythropoiesis, and prevent recurrent gallstones. A life-long risk of bacterial infection has been recognised for many years as a concomitant cost of splenectomy. The scope of this risk has expanded to include a number of organisms beyond the triad of pneumococcus, meningococcus, and haemophilus influenzae. Recently, it has been demonstrated that splenectomy also confers a significant risk of delayed adverse vascular events in patients with hereditary spherocytosis, just as it does in patients undergoing splenectomy for other indications. Further, these same studies demonstrated a benefit of avoiding splenectomy: hereditary spherocytosis patients with a spleen have significantly fewer adverse vascular events than unaffected family members, probably because of the protective effect of chronic, mild anaemia. Accordingly, this review marshals the evidence favouring a conservative approach to splenectomy in spherocytosis.

This article depicts the changing demographic portrait of social work education in the United States from 1974 through 2000 and considers the demographic shifts in the profession of social work. During this period, BSW and joint MSW-BSW programs increased from 150 to 404, MSW programs increased from 79 to 139, and social work doctoral programs increased from 29 to 67. BSW graduates increased by 24 percent to almost 12,000, MSW graduates grew by almost 90 percent to over 15,000, and doctoral graduates increased by 44 percent to only 229. From 1974 to 2000, people of color represented increasing proportions of social work graduates to almost 30 percent of BSW graduates, 26 percent of MSW graduates, and 19 percent of social work PhD graduates. By 2000, the proportion of women earning social work degrees had grown to 88 percent at the BSW, 85 percent at the MSW, and 73 percent at the PhD levels, and women accounted for almost two-thirds of social work faculty. The most dynamic trends within the composition of the profession are the substantial increases in the proportion of women faculty, and among MSW graduates, a decrease in the proportion of men from 43 percent in 1960 to 15 percent in 2000. Findings suggest that issues of racial, ethnic, and gender representation in particular merit discussion within the profession.

Because anemic persons have lower cholesterol and whole blood viscosity than those who are not anemic, we hypothesized that subjects with hereditary spherocytosis who have not had the spleen removed should have fewer arteriosclerotic events than unaffected family members. We defined arteriosclerotic events as myocardial infarct, stroke, coronary artery surgery, and carotid artery surgery. We compared the rate of these events in affected-not splenectomized persons to the rate in unaffected family members. The relative risk of an arteriosclerotic event in hereditary spherocytosis patients with a spleen was one fifth that in unaffected family members. These data support the hypothesis that chronic anemia retards the development of arteriosclerosis. Spherocytosis is another example of an inherited condition that conveys an advantage in one system and a disadvantage in another.

This study was designed to test the hypothesis that thalassemia trait diminishes the likelihood of myocardial infarction. If the hypothesis is true the prevalence of thalassemia trait should be less in myocardial infarct patients than in a control population. Blood counts and blood chemistry data from 500 men in Taiwan with a discharge diagnosis of myocardial infarction were recorded, and similar data were gathered on 500 men admitted to the same hospital for a routine check-up. Thalassemia trait was diagnosed via a discriminant function applied to the red blood cell count and indices. The study was done in a large modern hospital in Taipei; 14 of the 500 infarct patients and 33 of the 500 non-infarct subjects had thalassemia trait as defined here. The prevalence of thalassemia trait in myocardial infarct patients is significantly less than in the control subjects. This case control study supports the hypothesis that thalassemia trait lessens the risk of myocardial infarction.

A woman’s drug and alcohol use has been found to increase her risk of experiencing intimate partner violence (IPV). Objective The study describes the rates of lifetime and current IPV among women awaiting care in an emergency department and explores the association between IPV and having a drug abuse problem, and IPV and having an alcohol abuse problem, after controlling for demographic factors and history of childhood victimization. Methods Face-to-face interviews were conducted with 143 low-level triaged women recruited from an inner-city emergency department. Results Nearly one-half reported ever experiencing IPV, and over 18% reported IPV during the year before the interview. A higher proportion of abused women reported a history of regular crack, cocaine, or heroin use and visiting shooting galleries or crack houses. Participants who were physically abused by their partner during the past year (15%, n = 21) were more likely than nonabused women (85%, n = 122) to report higher scores on the Alcohol Use Disorders Identification Test (AUDIT) (4.9 vs. 2.4), a measure of alcohol-related problems, and the Drug Abuse Severity Test (DAST) (3.0 vs. 1.3), a measure of drug-related problems. Sexually abused women (6%, n = 9) were more likely than their counterparts (94%, n = 134) to have significantly higher AUDIT scores (6.4 vs. 2.5). The findings have implications for how the intersecting public health problems of IPV and substance abuse should be taken into consideration in research and patient care protocols in emergency departments.

This study expands upon coupon distribution strategies used to measure male condom acquisition in HIV/AIDS prevention by incorporating both female and male condoms and examining factors related to coupon redemption among urban STD clinic patients.In this study, condom coupon redemption (CR) rates were examined for male and female condoms. The study also explored the relationship between demographic and sexual behavior characteristics and CR and describes male and female participants requesting female condoms. The participants of this study were 100 patients, 55 male and 45 female, recruited from STD clinics by means of posted advertisements. Logistic regression analysis was used to explore the association between sexual risk factors, unprotected sexual intercourse, recent multiple sexual partners, STDs, and CR. Demographic screening revealed that 39% of the 100 participants redeemed coupons and females were more likely to redeem coupons than males. No association was found between sexual risk behavior and CR. Redeemers were slightly less sexually active than nonredeemers. Among coupon redeemers, 65% of women and 44% of men reported that they used the female condom at least once and 64% said that the device was easy to insert. Non-Latino women were the predominant users of female condoms, and more Latino men requested female condoms. This study found that there was no association between sexual risk behaviors and CR. CR, incorporating both condom types, would then provide a stronger measure of consumer preference of one type over the other.

The correlates of high-risk women's intentions to use the female condom were investigated in a descriptive study involving 148 sexually active women from 3 US methadone clinics. 51% of women were Latina and 38% were African-American; the mean age was 39 years. Male condoms, douching, sterilization, and withdrawal were the most frequently used contraceptive methods in the 90 days preceding the study. 56% had heard of the female condom, but only 6% had used it. Of the 139 women who had never used the female condom, 32% indicated they intended to use it in the future. Such intention was significantly, positively correlated with age under 39 years, African-American ethnicity, and the belief the female condom offers users a sense of personal control over their sexuality. Those who intended to use the female condom were more likely to have previously used male condoms, believe their partners would be supportive of the device, think female condom use could be erotic and fun, feel confident in their ability to negotiate safer sex, and to welcome an additional option for practicing safer sex. They were also less likely than their counterparts, who did not intend to use a female condom, to believe use of this method would imply they had a sexually transmitted disease or were too eager to have sex. Compared with women who did not intend to use the female condom, those who did were more likely to discuss the device with at least 1 member of their social network. These findings confirm the necessity of considering gender relations and social networks in the design of female condom promotion strategies.

Despite a slowing of the rates of human immunodeficiency virus (HIV) infection among intravenous drug users, this group remains at high risk for contracting acquired immune deficiency syndrome (AIDS). Promising reports of safer drug use patterns among addicts notwithstanding (Coleman, Lodico, Evans, & DiClemente, 1992; Sorensen, Batki, Coates, & Gibson, 1988; Watters et al., 1988), untreated drug users continue to share needles (Neaigus et al., 1992; Ortiz et al., 1992; Robles, Matos, Cancel, & Colon, 1992). Moreover, there is as yet little evidence of sustained safer sexual practices among drug users and their partners (Abdul-Quader et al., 1992; El-Bassel et al., 1992). In an ongoing series of studies, the authors are testing a small-group skills-training approach to reducing HIV-risk behavior among methadone patients. Earlier reports of these investigations have described the study methodology and preliminary outcomes (El-Bassel & Schilling, 1992; Schilling, El-Bassel, Schinke, Gordon, & Nichols, 1991). This article describes the conceptual components and strategies of a skills-building intervention model consisting of 13 weekly sessions followed by six monthly booster sessions. Social workers, many trained in group work and cognitive-behavioral approaches, would be positioned to initiate, and possibly carry out, such groups in chemical dependency treatment settings. Methadone Maintenance Methadone maintenance has been shown to be an effective approach to treating large numbers of heroin addicts, thereby reducing the risk of HIV infection associated with the sharing of intravenous drug paraphernalia (Ball & Ross, 1991; Murphy & Rosenbaum, 1988; Sorensen et al., 1988). Paradoxically, studies in the past several years have at once revealed both the protective effects and critical shortcomings of methadone maintenance treatment programs (MMTPs). Opiate relapse, alcohol and cocaine use, program attrition, and sexual risk-taking all present serious challenges to such programs (Obuchowsky & Zweben, 1987; Roszell, Calsyn, & Chaney, 1986; Schilling, El-Bassel, Gilbert, & Schinke, 1991). These challenges underscore the need for enhancing the nonpharmacological services of methadone clinics (Rounsaville & Kleber, 1985; Sorensen, 1991; Weddington, 1991). Most methadone patients receive medication several times per week. Their attendance is usually predictable. Counseling services would seem to be a natural extension of MMTP programs, and indeed federal regulations require programs to provide supportive services along with medication. Unfortunately, MMTPs have always had limited counseling components, and resources for supportive programs, including social work services, have eroded in recent years (Ball & Corty, 1988; Hubbard et al., 1989). Even if AIDS were not a consideration, MMTPs might benefit from sociobehavioral interventions that help clients to anticipate relapse, avoid high-risk situations, and recover from temporary lapses (Stark, 1989; Weddington, 1991). The AIDS crisis brings the need for MMTP program enhancements to the foreground. In response to this need, we developed and tested a set of theoretically and empirically derived intervention strategies designed to reduce drug use and high-risk sexual behavior among MMTP patients. Theoretical and Empirical Foundations of Training The underpinnings of the intervention are drawn from social learning theory (Bandura, 1977), health behavior models (Bandura, 1977; Cronkite & Moos, 1984; Wesson, Havassy, & Smith, 1986), theories of expectancy (Christiansen & Goldman, 1983; Marlatt & Roshenow, 1980) and self-efficacy (Baer, Holt, & Lichtenstein, 1986; Bandura, 1977; Donovan & Chaney, 1985; Heather, Rollnick, & Winton, 1983), relapse prevention (Marlatt & Gordon, 1985; Nurco, Stephenson, & Hanlon, 1991; Wesson et al., 1986), problem solving (Larson & Heppner, 1989; Nezu & D'Zurilla, 1981; Platt, Taube, Metzger, & Duome, 1988), skills training (Hawkins, Catalano, Gilmore, & Wells, 1989; Zackon, McAuliffe, & Ch'ien, 1985), self-regulation (Rehm & Rokke, 1988), social support (Fraser & Hawkins, 1984; Wesson et al. …

The black population is disproportionately affected by acquired immune deficiency syndrome (AIDS). Among those black people most at risk of becoming infected with the human immunodeficiency virus are black men who use intravenous drugs and black men who are gay. This article explores the complex cultural, economic, and social factors obstructing the reduction of the AIDS rate among these men. Implications and recommendations are made for developing effective AIDS prevention efforts by highlighting race-specific resources and supports for high-risk black men.

Untreated substance users remain beyond the reach of most acquired immune deficiency syndrome (AIDS) prevention efforts. In an effort to describe the risk behavior and attitudes of this population, the authors conducted interviews with 148 drug users in an urban soup kitchen. The study focused on subjects' risk-taking and risk-reduction behavior related to injection drug use, perceived changes in risk behavior, perceived risk for contracting AIDS, and socioeconomic and attitudinal correlates of injecting and sharing needles. Study findings underscore the need for community-based AIDS prevention strategies to intervene with high-risk populations beyond the reach of drug treatment and AIDS prevention programs.

African Americans and Latinos, respectively, account for 29% and 16% of persons with the acquired immunodeficiency syndrome, yet collectively represent less than 20% of the US population (Centers for Disease Control 1990) Although rates of human immunodeficiency virus (HIV) transmission have slowed among gay Anglo men there is less evidence to indicate that patterns of transmission have been altered among Black and Hispanic intravenous drug users. In this article, risk factors for HIV transmission among drug users are described, and sociocultural aspects of these risk behaviors are discussed Next, the advantages and disadvantages of various approaches to reducing the spread of HIV among drug users and their associates are considered, particularly as they apply to ethnic-racial minorities Finally, brief examples are provided of how existing theories of behavior change can be applied in Hispanic and African-American communities and suggestions are offered for further research

Purpose 1) To determine if there are significant differences in laboratory parameters and patient characteristics between patients with low erythrocyte (RBC) folate levels and those with normal RBC folate levels; 2) to determine the correlation between serum and RBC folate levels; 3) to determine if the RBC folate level changed the diagnosis, treatment, and outcome of these patients if the serum folate level was available. Patients and methods The study is a retrospective review of all inpatients and outpatients at a public teaching hospital who had an RBC folate level less than or equal to 175 ng/ml (N = 57) over the study period (69 months) and a blindly selected group of patients with RBC folate levels greater than 175 ng/ml (N = 53) during the same period. Results Patients with low RBC folate levels had higher mean corpuscular volume (MCV) and red cell distribution width (RDW) values and lower serum folate and B12 values than patients with normal RBC folate levels, but there was no difference in degree of anemia, presence of oval macrocytes and/or hypersegmented neutrophils on the peripheral blood smear, LDH, alcohol use, diet, or any other measured clinical parameter. Serum and RBC folate levels were highly correlated and a low RBC folate affected the clinical outcome of three patients (5% of the low RBC folate group). Conclusions Based upon these retrospective data and a review of the literature, we cannot define significant differences between patients with low RBC folate and randomly selected patients with normal RBC folate that could not have been equally well defined using serum folate values. The sensitivity and specificity of a low RBC folate level in the diagnosis of ill or healthy individuals are undefined, and until prospective studies utilizing some of the newer, more specific biochemical indicators of tissue folate are completed, the interpretation of low RBC folate levels will remain problematic.

The AIDS crisis, the increase in other sexually transmitted diseases (STDs), and the continuing problem of unwanted pregnancies, necessitate new methods of barrier protection. In 1988, Wisconsin Pharmacal began testing the safety and efficacy of a new female condom (Reality), a disposable, prelubricated, polyurethane device that is both a contraceptive and a barrier against STDs. The product requires no professional fitting and is inserted by the woman. Preliminary data from clinical and laboratory studies indicate that the female condom may be an effective barrier against STDs. A widespread use of the female condom, however, will depend on women's and men's initial attitudes, including culturally determined barriers to acceptance.

Hispanic adolescents are the fastest growing ethnic-minority age group in America. They are also at high risk for drug, alcohol, and tobacco use. In this paper, the authors discuss the etiology of Hispanic adolescents' substance abuse, as explained in part by psychological stress. Based on the authors' research and on other data, a model for preventing substance abuse among Hispanic youths is presented. The model draws from coping, acculturation, social learning, and informal network theories. Concluding with a research agenda, the paper calls for descriptive, correlative, and intervention outcome studies to scientifically understand and prevent substance use among Hispanic adolescents.

Social support is receiving increasing attention as a concept valuable in understanding and improving client functioning. This review finds that social support is a complex phenomenon with potential drawbacks. Policymakers and practitioners are advised to use care in designing and implementing social support strategies and to consider both the benefits and the risks of social support interventions.

In a retrospective search for prognostic factors in 127 patients with chronic myelocytic leukemia we found that thrombocytopenic patients had a significantly shortened life-span. Patients with the Philadelphia chromosome lived longer and were significantly younger than those lacking it. Females lived longer than males. Numerous other single features failed to correlate significantly with survival, but several combinations of two did. Patients having a low hematocrit with a low white blood count had an impressively short life-span compared to all others. Those having a high cholesterol and a low uric acid survived significantly longer than all others.

In an effort to improve prediction of duration of survival in chronic lymphocytic leukemia, correlations between blood-cell morphology and survival were investigated. Blood films made on 108 patients at the time of diagnosis of chronic lymphocytic leukemia were reviewed by a single hematologist. Lymphocyte diameter and the fraction of lymphocytes containing nucleoli were both found to have an inverse correlation with survival. Bone-marrow aspirate films were available for 64 patients. Differential leukocyte counts showed that the median for marrow lymphocytes was 64%. Those patients with a greater than median proportion of lymphocytes on marrow aspirate had a shorter survival time than those with less than median.

THE RELATIONSHIPS between so cial workers and physicians have always been ambivalent, although social workers have sought to improve their pro fessional status by emulating physicians.1 They still criticize the medical model and object to the status and authority of physi cians, and, according to Kane, use large amounts of energy to assert the legitimacy and importance of their role in health care.2 Physicians have long espoused the importance of social factors in the preven tion and treatment of disease, but for the most part, they have not welcomed social workers as major allies. Changes within social work and medicine, however, may point toward an increasing collaboration between the professions. Citing recent developments in health care, the present authors argue that social workers and phy sicians have much to gain by emphasiz ing their mutual concerns and comple mentary roles.

Human intrinsic factor (IF) saturated with (60)Co-labeled cyanocobalamin ((60)CoB(12)) was purified and then iodinated with (125)I to yield (125)I-labeled IF-(60)CoB(12) preparations of high specific activity. Sephadex G200 and DEAE-cellulose chromatography of the iodinated IF-(60)CoB(12) complex showed coincidence of the major (125)I and the (60)Co radioactivity peaks. During starch-gel electrophoresis (60)Co radioactivity from noniodinated and iodinated complexes migrated to the same extent while (125)I radioactivity from the iodinated complex migrated slightly further anodally than did the (60)Co radioactivity. After the iodinated complex was mixed with antibody to the IF-B(12) complex (antibody II) the (125)I and (60)Co radioactivity were: (a) precipitated in similar amounts by antiglobulin serum. (b) eluted coincidentally in the 19S region on Sephadex G200, and (c) excluded to the same extent from starch gel during electrophoresis. After equilibrium exchange of IF "blocking" antibody (antibody I) for (60)Co-vitamin B(12) on (125)I-labeled IF. (125)I radioactivity from the IF-antibody I complex: (a) was precipitated by antiglobulin serum, (b) was eluated in the 19S region on Sephadex G200 gel filtration, and (c) migrated slowly towards the anode on starch-gel electrophoresis. Urinary excretion of (60)Co radioactivity in pernicious anemia patients after oral administration of (60)Co-vitamin B(12) bound to freshly prepared (125)I-labeled IF was similar to that obtained with noniodinated intrinsic factor. These results show that iodination of IF-(60)CoB(12) complex does not markedly alter the chromatographic, electrophoretic, antigenic, or absorption-promoting properties of IF.

OBJECTIVES: This study examines the relationship between sex trading and psychological distress and the implications of that relationship for prevention of human immunodeficiency virus among a sample of young women recruited from the streets of Harlem. METHODS: Interviews were conducted with 346 predominantly drug-using women, aged 18 to 29 years, of whom 176 had exchanged sex for money or drugs in the previous 30 days and were categorized as "sex traders." Psychological distress was measured by using the Brief Symptom Inventory. RESULTS: Sex traders scored significantly higher than non-sex traders on the General Severity Index and on eight of the nine subscales of the Brief Symptom Inventory. Multivariate analysis indicated that after adjustments were made for age; ethnicity; pregnancy; recent rape; perceived risk for acquired immunodeficiency syndrome; current, regular crack use; and current, regular alcohol use, sex traders scored 0.240 units higher on the General Severity Index than non-sex traders. CONCLUSIONS: Poor mental health and drug dependence may under-mine the motivation and ability of these sex traders to adopt safer sex behavior. Therefore, interventions need to be integrated with mental health services and drug treatment to reduce risk behavior in this population.

Research on single parents and on parents of handicapped children indicates that these groups experience extraordinary stress. The authors suggest that single and married parents of handicapped children have different available resources and therefore will appraise their circumstances differently. Questionnaires measuring parents' stress, life satisfaction, and perception of the child were administered to 33 single and 48 married mothers of handicapped children. No differences between these groups were found on total scores or on subscale scores. Differences between single and married mothers were found on 24 of 135 items. Most of the significant items related to family life in general rather than rearing a handicapped child. Findings are discussed in terms of social and economic supports, child rearing contributions of fathers, and implications for intervention.

Personal coping and social supports are presented as resources for parents of handicapped children. These closely linked concepts are viewed as increasingly of interest to practitioners and investigators who recognize that such parents encounter extraordinary stress. An overview of the difficulties faced by parents of handicapped children is followed by a review of several studies on coping among such parents. The authors describe a structured group approach to teach parents of handicapped children to use personal coping and social supports.